Modified simple percutaneous suprapubic cystostomy.

The procedure is done under local anaesthesia. Position of the enlarged bladder is confirmed by percussion. The skin is prepared as for a standard suprapubic cystostomy, and 2% lignocaine is infiltrated in the midline 2 cm above the pubic symphysis. Using a number 11 blade a vertical cut 1-2 cm in length is made in the midline. The incision is deepened and a small cut is made in the rectus sheath. With a mosquito forceps the rectus defect is enlarged and blunt dissection is done in the suprapubic fat till the resistance of the bladder is felt. The depth and position of the bladder are confirmed by inserting a 23 gauge needle on a syringe while aspirating.